The inspection took place on 4 July 2016, and was unannounced.Cedrus house provides accommodation, nursing and personal care for up to 70 people. At the time of our inspection there were 58 people living in the service. There are six individual units within the building. Each floor is divided into two suites, with each suite having its own dining room and living area.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Our previous inspection of 13 and 22 October 2015 found that improvements were needed in how the service completed assessments to accurately reflect individual needs and risks. There was also concern that clinical governance systems were not effective. The provider wrote to us and told us how they were addressing these shortfalls. During this inspection we found that some improvements had been made.
There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the service. This was through regular communication with people, surveys, spot checks on staff during the night, and a programme of other checks and audits. However, some audits could be used more effectively to implement further learning and change. Whilst the management team had made continued progress in addressing more effective systems and procedures, some were not yet fully embedded in practice, and we found that clinical guidance was not consistently followed.
Staffing numbers were assessed against and reflected people’s dependency needs, and we saw that staff responded to people in a timely manner. Staff took their time with people when delivering their care, and people were not rushed. However, we received some comments which indicated that the management team should review its current provision to ensure people’s needs are met at all times.
Care plans and risk assessments contained clear and detailed information which supported staff to meet people's needs. There was opportunity to improve care plans further by developing a more person-centred approach which focusses on a person’s whole life, including their emotional and social care needs.
Staff received the necessary training and support to enable them to do their jobs. The service had introduced monitoring tools which checked staff knowledge and understanding once training was completed.
Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.
Staff understood the principles of the Mental Capacity Act (MCA), and gained people's consent before they provided care. People told us they were encouraged to make choices about their daily lives. There were procedures in place to ensure that people who could not make decisions were protected, and we found assessments had been completed.
Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.
Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.
Systems were in place to ensure people's medicines were managed in a safe way, and people received their medicines in a timely manner. People were supported to maintain good health and have access to relevant healthcare services.
We saw people received a good choice of food and drink, and people's individual food requirements were well catered for.
A complaints procedure was in place. People’s concerns and complaints were listened to and addressed in a timely manner.